Orientador: Carlos Takahiro Chone / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T13:57:24Z (GMT). No. of bitstreams: 1 Moraes_JulianaLopesde_M.pdf: 943040 bytes, checksum: 4d94adb829d86ae614ad5e737c31b7af (MD5) Previous issue date: 2014 / Resumo: Objetivo: Comparar a qualidade de vida do paciente tratado cirurgicamente por câncer avançado de laringe com aquele que foi submetido a quimioradioterapia exclusivos. Método: Revisão sistemática que utilizou, para a seleção dos artigos, 06 bases de dados (PubMed, MedLine, Embase, Web of Science, Cochrane Library e Lilacs) e as palavras-chave "head and neck cancer"; "advanced laryngeal cancer"; "laryngeal neoplasm"; larynx cancer"; "quality of life"; "outcomes/functional results";"total laringectomy"; "chemoradiotherapy". Os critérios de inclusão foram estudos específicos de câncer avançado de laringe, com comparação de modalidades de tratamento e avaliação da qualidade de vida. Resultados: Foram encontrados 321 artigos. Nove artigos preencheram todos os critérios de inclusão e desses, apenas três possuíam desenho metodológico e instrumento de mensuração de qualidade de vida comparáveis entre si e foram submetidos à metanálise . Os resultados evidenciaram que 90% dos estudos são retrospectivos e não randomizados. O tempo pós-tratamento em que os questionários de qualidade de vida foram aplicados mostrou grande variabilidade (3 meses a 11 anos). Conclusão: A meta-análise dos três estudos comparativos mostraram uma melhor qualidade de vida após o tratamento para indivíduos tratados com quimioradioterapia exlcusiva. No entanto, devido a existência de poucos estudos com dados relevantes na literatura, é necessário realizar pesquisas futuras com as seguintes características: (a) estudos prospectivos e randomizados, (b) multicêntrico, com maior número de indivíduos, e (c) enfatizando o funcional sequelas que ambos os tratamentos acarretam / Abstract: Objective: To compare studies of quality of life in patients undergoing chemoradiotherapy or surgery for advanced laryngeal cancer. Method: Articles were selected for a systematic review by searching six databases (PubMed, Medline, Embase, Web of Science, Cochrane Library and Lilacs) for keywords "head and neck cancer," "advanced laryngeal cancer," "laryngeal neoplasm," "larynx cancer," "quality of life," "outcomes and functional results," "total laryngectomy" and "chemoradiotherapy." The included studies must related to advanced larynx cancer, comparisons of treatment modalities and assessment of patient quality of life in validated scales, well defined inclusion and exclusion criteria. Articles with poor methodological evaluation and duplicated results were excluded. Results: It was found 321 articles. Nine articles fitted to all inclusion criteria and of these, only three observed comparable methodological designs and standardized instruments for measuring quality of life and therefore subjected to meta-analysis. Our analysis observed that 90% of the studies were retrospective and nonrandomized. The time point post-treatment at which the quality of life questionnaires were assessed varied widely (3 months to 11 years). Conclusion: The meta-analysis of three comparable studies showed improved quality of life after treatment for subjects treated with chemoradiation alone. However, because of few studies with relevant data in literature, it is necessary to conduct future research with the following study characteristics: (a) prospective and randomized; (b) multicentric, with larger numbers of subjects; and (c) emphasizing the functional sequelae that both treatments entail / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Disfonia é a principal sequela cirúrgica do paciente submetido à laringectomia parcial vertical (LPV) com presença de ruído glótico intenso o que dificulta a análise acústica convencional. Por esse motivo a análise não linear (ANL), teoria dinâmica de sistemas não lineares aplicada a séries temporais não lineares, tem sido recentemente adotada como uma nova abordagem para avaliação acústica vocal. Objetivo: aplicar a ANL por meio da escala L-IE na análise acústica da voz de pacientes submetidos à LPV. Método: foram analisadas 31 vozes de pacientes submetidos à LPV, denominado de grupo de pacientes (GP) e 31 vozes de indivíduos sem alteração vocal ou laríngea, denominado grupo controle (GC). Os gráficos bidimensionais gerados a partir dos sinais de voz foram avaliados com base na técnica dos padrões visuais da dinâmica vocal (PVDV), por meio da escala de classificação L-IE para os três parâmetros: número de laços (L), irregularidade (I) e espaçamento (E). Para a correlação dos dados da ANL com a avaliação perceptivo-auditiva da voz, as vozes do GP foram avaliadas por meio da escala GRBAS. Resultados: houve correlação significativa (p<0,05) entre os três parâmetros da escala L-IE para a análise total da amostra GP e GC. Os resultados da escala L-IE para a maioria do pacientes do GP se caracterizaram por: número de laços zero; irregularidade e espaçamento dos traçados, ambos com grau 6. O GP teve a maioria de suas vozes avaliadas com grau 3 de disfonia na escala GRBAS. Houve correlação estatisticamente significante (p<0,05) entre a escala L-IE e a GRBAS nos seguintes parâmetros: o \"L\" com o grau global da disfonia (G) e com soprosidade (B) e o \"I\" com a soprosidade (B). Conclusão: o método da ANL por meio da escala L-IE, se mostrou eficiente na avaliação das vozes de pacientes submetidos a LPV. / Dysphonia is the main surgical sequel in patients who underwent vertical partial laryngectomy (VPL) with the presence of intense glottal noise which makes more difficult conventional acoustic analysis. Therefore the nonlinear analysis, dynamic theory of nonlinear systems applied to nonlinear time series, has recently been adopted as a new approach to acoustic analysis of voice. Objective: apply to ANL by L- IS scale on acoustic voice analysis of patients underwent VPL. Method: 31 voices of patients underwent VPL called patient group (PG) and 31 voices of individuals without vocal or laryngeal disorder were analyzed called control group (CG). Two-dimensional graphs generated from the voice signals the both groups were evaluated based on the technique of VDVP through the rating scale L-IS for the three parameters: number of loops (L), irregularity (I) and spacing (S). For the correlation of data from nonlinear analysis with the perceptual evaluation, the voices of the PG were evaluated by GRBAS scale. Results: significant correlation (p <0.05) between the three parameters of the L-IS scale for the total sample analysis PG and CG. The results of the L-IS scale for the majority of PG patients were characterized by: zero for number of loops; 6 degree for both irregularity and spacing of the traces. The PG had most of their voices evaluated with 3 degree of dysphonia in GRBAS. There was a statistically significant correlation (p<0.05) between L-IS and GRBAS parameters: \"L\" with the overall grade of dysphonia (G) and breathiness (B) and \"I\" with breathiness (B). Conclusion: the method of ANL by L-IS scale, is efficient for evaluating the voices of patients underwent VPL.

INTRODUÇÃO: a laringectomia parcial supracricóide é uma possibilidade de tratamento que permite a preservação das funções laríngeas e um bom controle oncológico local da doença. Até o momento não foram localizados estudos que apontem o tempo mais indicado para execução de exercícios vocais para pacientes submetidos a essa cirurgia. OBJETIVO: avaliar a efetividade do exercício de [b] prolongado associado à vogal grave com pressão tóraco-abdominal após laringectomia supracricóide por meio da configuração laríngea e tempo de execução. MÉTODOS: a amostra foi composta por 11 pacientes submetidos à laringectomia parcial supracricóide após reestabelecimento da alimentação via oral exclusiva. Todos os participantes foram submetidos à nasofibroscopia para análise da configuração laríngea durante a execução do exercício e gravação de voz para análise perceptivo-auditiva e acústica. A gravação foi realizada em seis momentos: momento zero (M0), antes da primeira execução do exercício, e em mais cinco momentos: minuto um (M1), minuto dois (M2), minuto três (M3), minuto quatro (M4) e minuto cinco (M5) e em cada intervalo foi realizada gravação das tarefas vocais. Ao final totalizou-se a realização do exercício por cinco minutos. Para a análise da confiabilidade intra-juiz e inter-juizes foram inseridas repetições de 70% das vozes e utilizado o Coeficiente de Correlação Intraclasse. Para análise de cada juiz para a comparação entre M0, M1, M2, M3, M4 e M5 foi considerado como nível de significância p <= 0,05. A análise acústica não linear foi realizada pelo Programa MatLab® 10.0. RESULTADOS: na análise da configuração laríngea observou-se mudança da atividade supraglótica ântero-posterior e vestibular mediana durante a realização do exercício, porém sem significância estatística. Na análise perceptivo-auditiva, houve melhora nos parâmetros grau geral de desvio vocal, rugosidade, tensão e soprosidade a partir de quatro minutos considerando os dois juízes com maior índice de confiabilidade. A análise acústica não linear mostrou todos os parâmetros alterados e não foi capaz de detectar mudanças entre os diferentes momentos. CONCLUSÃO: a execução do exercício do [b] prolongado associado a vocal grave com pressão tóracoabdominal aumenta a intensidade da atividade supraglótica ântero-posterior e vestibular mediana. A realização do exercício a partir de quatro minutos de execução apresenta melhora quanto ao grau geral de desvio vocal, rugosidade, tensão e soprosidade. A análise acústica não apresentou resultados significativos, não sendo possível captar medidas ou modificações entre os momentos / INTRODUCTION: Partial supracricoid laryngectomy is a feasible treatment that allows the preservation of laryngeal functions and an appropriate local oncological disease control. Currently, we did note find studies that indicate the most appropriate time to perform vocal exercises for patients who underwent this surgery. PURPOSE: to assess the effectiveness of prolonged exercise of the consonant [b] associated to the vowel with thoracoabdominal pressure after supracricoid laryngectomy through the execution time technique. METHODS: the sample consisted of 11 patients, who underwent partial supracricoid laryngectomy after reestablishment of exclusive oral feeding. All participants underwent nasofibroscopy to analyze the laryngeal configuration during exercise and voice recording for perceptual-auditory and acoustic analysis. The recording was performed in six moments: zero moment (M0), before the first execution of the exercise, and in another five moments: minute one (M1), minute two (M2), minute three (M3), minute four(M4) and minute five (M5) and at each interval recording of the vocal tasks was performed. At the end, the exercise was completed for five minutes. For intrajudge reliability analysis and inter-judges, 70% repetitions of the voices were inserted and the Intraclass Correlation Coefficient was used. For the analysis of each judge for the comparison between M0, M1, M2, M3, M4 and M5 was considered as level of significance p <= 0.05. Non-linear acoustic analysis was performed by the MatLab® 10.0 Program. RESULTS: in the analysis of the laryngeal configuration, the supraglottic activity of the anteroposterior and medial vestibular variables was observed during the exercise, but with no statistical significance. In the perceptual-auditory analysis, there was improvement in the parameters general degree of vocal deviation, roughness, tension and breathiness from four minutes considering the two judges with the highest reliability index. The non-linear acoustic analysis showed all altered parameters and was not able to detect changes between the different moments. CONCLUSION: the exercise execution of the prolonged [b] associated with severe vocal cords with thoraco-abdominal pressure increases the intensity of antero-posterior and medial vestibular supraglottic activity. The performance of the exercise from four minutes of execution improves the general degree of vocal deviation, roughness, tension and breathiness. The acoustic analysis did not present significant results, and it was not possible to capture measurements or modifications between moments

Introdução: A aringectomia subtotal permite a preservação da função da laringe com um bom controle oncológico local da doença, além de manter uma comunicação satisfatória, traqueostomia temporária e disfagia passível de terapia fonoaudiológica. Objetivos: Descrever resultados da avaliação vocal, estruturas remanescentes, comportamento laríngeo em tarefas específicas e resultados da avaliação de deglutição; e comparar a funcionalidade das estruturas remanescentes com os parâmetros de voz e deglutição após laringectomia com cricohioidoepiglotopexia (CHEP) e traqueohioidoepiglotopexia (THEP). Método: Estudo transversal observacional comparativo em que participaram 15 indivíduos submetidos à laringectomia subtotal reconstruídos com CHEP (12) e THEP (3), após restabelecimento da alimentação via oral. Foram avaliados por meio da captação/registro de amostra de fala para análise perceptivo-auditiva, acústica e de agradabilidade da voz; nasofibrolaringoscopia para análise estrutural e exames de deglutição. Resultados: Foi observado grau acentuado de tensão e de desvio de loudness e as vozes foram consideradas desagradáveis. Quanto às estruturas remanescentes, a maioria apresentou atividade supraglótica vestibular mediana e anteroposterior moderadas durante fonação de vogais. A penetração laríngea silente foi encontrada na maioria dos indivíduos, mas nem sempre seguida de aspiração. Na comparação entre as estruturas remanescentes e os resultados funcionais de voz e deglutição, não houve significância estatística em nenhum dos parâmetros avaliados. Conclusão: Indivíduos submetidos à laringectomia subtotal mantêm disfonia acentuada e comumente episódios de penetração silente sem aspiração laringo-traqueal. Não houve significância estatística na comparação entre a funcionalidade das estruturas remanescentes e os parâmetros vocais e deglutição; o número de aritenóides preservado não se mostrou fator prognóstico para parâmetros positivos na avaliação vocal e eficiência da deglutição. Os diferentes ajustes neolaríngeos inviabilizaram estudo de correlação entre as variáveis / Introduction: Subtotal laryngectomy preserve larynx functions and allows adequate local oncological control and also provide an effective communication to the individual, temporary tracheostomy and dysphagia liable to speech-therapy intervention. Purposes: Describe results of vocal assessment, remaining structures, laryngeal behavior in specific tasks and the evaluation of swallowing; and also compare the functioning of remaining structure to voice and swallowing parameters after laryngectomy with cricohyoidoepiglottopexy (CHEP) traqueohyoidoepiglottopexy (THEP). Methods: Comparative observational cross-sectional study which counted on 15 individuals who underwent subtotal laryngectomy reconstructed with CHEP (12) and THEP (3), after re-establishment of oral feeding route. All individuals were assessed through capture/record of a speech sample for both perceptual-acoustic and voice pleasantness analysis, nasofibrolaryngoscopy for structural analysis, and swallowing examination. Results: We noticed pronounced level of tension and loudness deviation and the voices were considered little pleasant or unpleasant. Concerning remaining structure, the majority of individuals presented median vestibular supraglottic activity and moderated activity anteroposterior during phonation of vowels. Silent larynx penetration was found in the most part of individuals, although not commonly related to aspiration. The comparison between remaining structures and functioning results of voice and swallowing pointed no statistical significance among the assessed parameters. Conclusion: Individuals who underwent subtotal laryngectomy maintain pronounced dysphonia e often episodes of silent penetration without laryngotracheal aspiration. There was found no statistical significance between remaining structure functioning and both vocal and swallowing parameters; quantitatively, the maximum phonation time of arytenoid cartilage may influence on both voice pleasantness and perceptual-acoustic analysis

Eine Laryngektomie führt zu teils irreversiblen Einschränkungen von Kommunikation, Sinneswahrnehmungen und Atmung. Unklar ist, bis zu welchem Ausmaß resultierende Symptome als „normal“ und „akzeptabel“ anzusehen sind. Ziel dieser Promotionsarbeit war daher die Festlegung von Cut-off-Werten für die gesundheitsbezogene Lebensqualität von laryngektomierten Karzinompatienten. In einer multizentrischen Querschnittsstudie bestimmten 28 Patienten und 24 Experten für den Lebensqualitätsfragebogen EORTC QLQ-C30 und das entsprechende Modul für Patienten mit Kopf-Hals-Tumoren (EORTC QLQ-H&N35), wo für sie die Grenze einer gerade noch akzeptablen Lebensqualität liegt. Untersucht wurde einerseits die Übereinstimmung zwischen diesen beiden Gruppen und andererseits, inwieweit eine repräsentative Gruppe von 157 Laryngektomierten die von den patienten-definierten Werte erreichte. Die Cut–off-Werte für die Symptomskalen wurden durch die Patienten zwischen 9,1 und 56,5 festgelegt (0 entspräche keinen Symptomen, 100 der höchsten Ausprägung). Die befragten Patienten akzeptierten dabei Einschränkungen der Sinne (56,5) sowie Husten (53,6) und Dyspnoe (44,0) im höchsten Maße, dagegen wurden Obstipation (9,1) sowie Übelkeit und Erbrechen (10,7) am wenigsten toleriert. Auf den Funktionsskalen (100 entspräche keinen Defiziten, 0 stärksten Beeinträchtigungen) wurden die meisten Einschränkungen in Rollenfunktion (63,7) und emotionalem Funktionsniveau (67,6) toleriert, am wenigsten dagegen eine Minderung der kognitiven Funktion (91,1). Die Experten hielten mehr Einschränkungen für akzeptabel als die Patienten, insbesondere in psychosozialen Domänen. Auf den Skalen wurden die patienten-definierten Zielwerte von 34,5% (Sinne) bis 86,5% (Obstipation) der 157 Laryngektomierten erreicht. Zusammenfassend zeigte sich, dass krankheits– oder therapiebedingte Einschränkungen bis zu einem hohen Maß von den Patienten toleriert und eher akzeptiert werden als unspezifische, eventuell auch behandelbare Symptome. Die hier festgelegten spezifischen Zielwerte könnten eine Hilfestellung bei der Interpretation von Lebensqualitätsdaten und auch der Therapie eines individuellen Patienten im klinischen Alltag sein.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Post-operative laryngectomy patients face various physical, psychological and social challenges. The comprehensive effects of a total laryngectomy can have an adverse impact on the patient and his or her family. Because improved medical treatment can increase the life expectancy of cancer sufferers, psychosocial guidance is required over an extended period. Unfortunately, limited information on the coping strategies of such patients is available. The social work profession could benefit from greater insight into the strengths and coping mechanisms of post-operative cancer patients in order to guide them through their survivorship journey with insight and compassion. The researcher therefore aimed to explore and describe the experience of a patient and his/her close family while coping with the long-term challenges of a laryngectomy. The objectives were: (1) to discuss the nature of cancer survivorship, (2) to describe the medical aspects of and physical re-adjustments to a laryngectomy, (3) to discuss principles and strategies for coping and surviving a laryngectomy, (4) to describe the comprehensive psychosocial effects during the permanent survival phase and re-entry into society; (5) to explore the survivorship journey of laryngectomy patients and their families, and (6) to analyse and interpret data obtained from the study. Each of the survivorship phases as contextualised by Miller et al. (2008:369-374)* is discussed in the literature review. Both the ecological and the strengths perspective were utilised as the theoretical framework for this study. Principles of the strengths perspective focus on the inherent strengths that help patients cope with this traumatic life event, while the ecological perspective focuses on the utilisation of community resources in order to survive the laryngectomy experience. A combination of exploratory and descriptive designs was applied throughout the study to gain insight into the survival experience of post-operative laryngectomy patients and their families. The research question was: “What are patients’ and families’ experiences of surviving a laryngectomy with the assistance of internal and external resources within the family system and environment?” This question was addressed by combining the quantitative and qualitative research approaches. Forty-five post laryngectomy patients and fifteen family members, representing one-third of these patients, were included in the study through purposive sampling. The study period was from June 2012 to July 2013. The inclusion criteria required: (1) Patients from the service area of the selected hospital who received a total laryngectomy as surgical treatment for an advanced stage of cancer of the larynx or hypopharynx; (2) patients who were operated on not less than three months previously; (3) patients who had already completed their initial treatment and who were attending the follow-up clinic; and (4) patients who had successfully acquired trachea-oesophageal speech. Data obtained from the interviews were organised into themes. Four themes were identified: (1) the need for pre-operative information; (2) experience of physical adjustment; (3) coping and strengths used; and (4) experience of psychosocial effects of surgery and re-entry into society. These themes were divided into sub-themes and categories. The main outcome of the study was that both patients and families mobilise a combination of inner strengths and external resources to adapt to the inevitable physical changes resulting from a laryngectomy. It is therefore recommended that social workers dealing with survivorship cases utilise a combination of the ecological and strengths perspectives to create an environment in which patients can explore their own inner strengths, or to help them link to community resources whilst coping with their survivorship journey. Future research should focus on the long-term psychosocial survival of laryngectomy patients and their families, as it is likely that survivorship will increase in future; the implementation of survivorship programmes for health care professionals to equip them with skills to guide cancer survivors to full utilisation of their own strengths and available community resources; the role of pre- and primary school children/grandchildren in the rehabilitation of laryngectomy patients deserves further investigation. / AFRIKAANSE OPSOMMING: Laringektomie-pasiënte word ná hul operasie met verskeie liggaamlike, psigiese en sosiale uitdagings gekonfronteer. Die omvattende gevolge van ‘n totale laringektomie kan die pasiënt en sy of haar gesin nadelig affekteer. Aangesien verbeterde mediese behandeling die lewensverwagting van kankerpasiënte kan verleng, word psigososiale ondersteuning oor ‘n langer tydperk benodig. Ongelukkig bestaan daar baie min inligting oor hoe pasiënte kanker hanteer. Die maatskaplike werk beroep kan dus voordeel trek uit beter insig in die hanteringsmeganismes van post-operatiewe kankerpasiënte om hulle met insig en empatie deur hul oorlewingsreis te kan begelei. Die navorser het ten doel gehad om die ondervindings van die kankerpasiënt en sy/haar naby familie tydens hul langtermynhantering van ‘n laringektomie te ondersoek en te beskrywe. Verdere oogmerke van die studie was: (1) om die aard van kankeroorlewing te bespreek; (2) om die mediese aspekte van en liggaamlike aanpassing ná ‘n laringektomie te beskrywe; (3) om die beginsels en strategieë vir ‘n oorwinning oor ‘n laringektomie te bespreek; (4) om die omvattende psigososiale gevolge van die finale oorlewingsfase en hertoetrede tot die gemeenskap te beskrywe; (5) om die oorlewingsreis van die laringektomiepasiënt en sy/haar gesin te ondersoek; en (6) om die resultate van die studie te ontleed en te interpreteer. Elk van die oorlewingsfases soos deur Miller et al. (2008:369-374)* beskrywe, is in die literatuuroorsig bespreek. Die ekologiese en die sterkte-perspektiewe is tesame as teoretiese raamwerk vir die studie gebruik. Die beginsels van die sterkte-perspektief is op die inherente krag van pasiënte gemik, om te bepaal hoe hulle hierdie traumatiese lewensgebeurtenis hanteer, terwyl die ekologiese perspektief op hul aanwending van gemeenskapsbronne om die laringektomie te oorleef, fokus. ‘n Kombinasie van ondersoekende en beskrywende navorsings ontwerpe is deurgaans gebruik om insig in die oorlewingstryd van laringektomiepasiënte en hul gesinne te verkry. Die navorsingsvraag was: “Wat is pasiënte en hul gesinne se ervarings van oorlewing na ‘n laringektomie met die hulp van interne en eksterne hulpbronne in die gesinstruktuur en omgewing?” Kwantitatiewe en kwalitatiewe navorsingsmetodes is gekombineer om hierdie vraag te ondersoek. Vyf-en-veertig laringektomiepasiënte en vyftien gesinslede, wat verteenwoordigend van twee-derdes van die pasiënte was, is met behulp van ‘n doelbewuste steekproef by die studie betrek. Die studie is tussen Junie 2012 en Julie 2013 onderneem. Die insluitingskriteria was: Pasiënte uit die diensgebied van die spesifieke hospitaal wat 'n totale laringektomie as chirurgiese behandeling vir 'n gevorderde stadium van kanker van die larinks of hipofarinks ontvang het; (2) pasiënte wat hul operasie nie meer as drie maande vantevore ondergaan het nie, (3) pasiënte wat reeds hul aanvanklike behandeling voltooi het en wat die opvolgkliniek bywoon, (4) pasiënte wat tragea-esofageale spraak suksesvol bemeester het. Die data, wat deur middel van onderhoude ingesamel is, is in temas gegroepeer. Vier temas is geïdentifiseer: (1) die behoefte aan inligting voor die operasie; (2) ervaring van liggaamlike aanpassing; (3) die hantering van omstandighede en innerlike krag; en (4) ervaring van die psigososiale uitwerking van die operasie en hertoetrede tot die gemeenskap. Hierdie temas is verder in subtemas en kategorieë verdeel. Die belangrikste uitkoms van hierdie studie is dat beide pasiënte en gesinne ‘n kombinasie van hul innerlike krag en eksterne bronne aangewend het om ná die laringektomie by die onafwendbare liggaamlike veranderinge aan te pas. Daar word dus aanbeveel dat maatskaplike werkers wat kankeroorlewendes hanteer, van ‘n kombinasie van die ekologiese en die sterkte-perspektief gebruik maak om ‘n omgewing te skep waarin die pasiënt sy of haar eie innerlike krag kan ontgin, of om pasiënte te help om kontak met gemeenskapsbronne te maak terwyl hulle die oorlewingsreis baasraak. Toekomstige navorsing behoort te fokus op langtermyn psigososiale oorlewing van laringektomie pasiënte en familie met inagneming van die tendens dat kanker pasiënte se oorlewing toeneem; die implementering van opleidingsprogramme vir gesondheidswerkers te fokus om hulle met die nodige kennis toe te rus om kankeroorlewendes te begelei om hul volle krag en alle beskikbare gemeenskapsbronne te gebruik. Daarby verdien die rol van voorskoolse- en laerskoolkinders in die rehabilitasie van laringektomiepasiënte verdere ondersoek.

Thesis (M Social Work(Social Work))--University of Stellenbosch,2009. / A laryngectomy is mostly indicated as treatment for an advanced stage of cancer of the larynx, during which the patient’s voice box is removed. This operation can hold major psycho-social implications for the patient and family. To cope with the challenges in daily life, patients need social support. A lack of available literature and research regarding the role of the social worker in facilitating support groups for these patients and families was identified and motivated this research study. The goal of the study was to gain a better understanding of the laryngectomy patient’s need for support groups in a hospital setting when attending the follow-up clinic at the hospital. A combination of both the exploratory and descriptive research designs together with a combination of mainly a qualitative and to a certain extent the quantitative research approaches, was used. From this, knowledge, insight and an understanding of the need for support groups in a hospital setting from a social work perspective were obtained. Permission to conduct the proposed study was granted by the Committee for Human Research at the University of Stellenbosch. The literature study first focused on medical aspects of a laryngectomy and social work intervention services within a hospital setting as part of the multi-disciplinary approach. Second, psycho-social effects of a laryngectomy from an ecological perspective were discussed, referring to the physical, social and psychological effects of surgery upon the patient and family. Third, support and aftercare were discussed with specific reference to the role of the social worker in offering social support to the patient and family. For the empirical study, twenty laryngectomy patients from the service area of Tygerberg Hospital were involved from January 2008 to May 2008. Criteria for inclusion in the study referred to patients who had their operation not less than three months previously, attended the support group during follow-up visits at the hospital and who had successfully acquired tragea-oesophageal speech. Based on the literature review, a semi-structured questionnaire and face-to-face interview were used as research instruments to overcome the limitation of illiteracy. The results of the investigation mainly confirmed the findings of the literature study namely that laryngectomy patients can benefit from support groups in order to address their need for social support in dealing with daily life challenges. Patients indicated that they mainly needed information regarding post-operative adaptation as this was where problems were mostly experienced. The majority of patients suggested the use of support groups in this regard. Focus was placed on an exploration and description of patients’ needs for such support groups. Benefits of support groups were found to be totally compatible with the role of the social worker. The results therefore gave an indication of social work intervention services and referred to: provision of information, problem-solving, offer of social and emotional support, and promotion of rehabilitation opportunities, thereby improving the patient’s quality of life. Recommendations were aimed at social work intervention services relating to support and aftercare offered to laryngectomy patients and relatives. Future research to develop social work programmes for health care professionals in order to effectively support these patients and their families was proposed. From practical experience of support groups a study regarding the role of pre- and primary schoolchildren or grandchildren in the rehabilitation of laryngectomy patients was also suggested.

Introdução: Quando um indivíduo é acometido pelo câncer de laringe e o tratamento indicado é a laringectomia total, o aspecto que apresentará maior modificação é a fonação, uma vez que a voz laríngea não será mais possível e a reabilitação com um novo método de comunicação alaríngea torna-se necessária para reestabelecer esta função. Entre os métodos de escolha, está a voz esofágica (VE) que apresenta variabilidade de sucesso. Entender como e quanto estas modificações poderão impactar na qualidade de vida e quais os protocolos mais indicados para esta população poderá favorecer as chances de sucesso terapêutico e ajudar na reinserção desse indivíduo no meio social e familiar. Objetivo: Comparar diferentes protocolos de qualidade de vida em laringectomizados totais falantes e não falantes por meio da voz esofágica. Métodos: Trata-se de um estudo transversal observacional com 38 laringectomizados totais com voz esofágica, classificados 19 no grupo falantes e 19 não falantes. Foram aplicados a escala EAV e os protocolos IDV, QVV, FACT - H&N, EORTC QLQ - C30, EORTC QLQ - H&N35 e UW - QOL. Resultados: Observou-se que os laringectomizados totais reabilitados com voz esofágica, quando comparados, apresentaram melhores escores com diferença estatística no domínio funcional para o grupo falantes. Notou-se forte correlação inversamente proporcional no grupo falantes, não falantes e total da amostra com o QVV e IDV. Houve correlação forte e moderada com a escala funcional do EORTC QLQ - C30 com todos os demais protocolos, em ambos os grupos. A correlação entre o EORTC QLQ - H&N35 e o UW - QOL foi moderada no grupo falantes e forte no grupo não falantes. O UW - QOL apresentou ainda correlações entre moderadas e fortes com IDV e EORTC QLQ - C30 em ambos os grupos. Conclusão: O protocolo EORTC QLQ - C30, com seu específico EORTC QLQ - H&N35, e o UW - QOL foram os que mais se correlacionaram com os demais protocolos, podendo optar-se por um deles para avaliar a qualidade de vida desta população / Introduction: When an individual is affected by laryngeal cancer and the treatment chosen is total laryngectomy, the aspect that will present the greatest modification is phonation, since the laryngeal voice will no longer be possible and rehabilitation with a new method of communication is necessary to re-establish this function. Among the methods of choice is the speech esophageal (SE), which shows variability of success. Understanding how these modifications may impact the quality of life and which protocols are the most appropriate for this population may favor the chances of therapeutic success and help in the reintegration of this individual in the social and family environment. Objective: To compare different quality of life protocols in total laryngectomized speakers and non-speaking patients through speech esophageal. Methods: This is an observational cross-sectional study with 38 total laryngectomized people with speech esophageal, classified 19 in the group of speakers and 19 non-speaking. The VAS scale and the VHI, V-RQOL, FACT-H & N, EORTC QLQ - C30, EORTC QLQ-H & N35 and UW - QOL protocols were applied. Results: It was observed that total laryngectomies rehabilitated with speech esophageal, achieved better scores with statistical difference in the functional domain for the speaking group. There was a strong inversely proportional correlation in the group of speakers, non-speakers and total sample with QOL and VHI. There was a strong-moderate correlation with the EORTC QLQ - C30 functional scale and all other protocols in both groups. The correlation between the EORTC QLQ-H & N35 with the UW - QOL was moderate in the group speakers and strong in the nonspeaking group. UW - QOL also showed moderate to strong correlations with VHI and EORTC QLQ - C30 in both groups. Conclusion: The EORTC QLQ - C30 protocol, with its specific EORTC QLQ-H & N35, and UW - QOL were the ones that most correlated with the other protocols, being able to be used by anyone who wants to evaluate the quality of life of this population

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-08-01T11:33:52Z No. of bitstreams: 1 Nathália Dos Reis.pdf: 6098992 bytes, checksum: 8086672011bbdc448fbdfde6bb8719ca (MD5) / Made available in DSpace on 2018-08-01T11:33:52Z (GMT). No. of bitstreams: 1 Nathália Dos Reis.pdf: 6098992 bytes, checksum: 8086672011bbdc448fbdfde6bb8719ca (MD5) Previous issue date: 2018-06-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research integrates the field of the investigations of the alaryngeal speech with support of the field of Acoustic Phonetics. The aim of this study was to analyze, from an acoustic point of view, the quality of the tracheoesophageal speech and the characteristics of the stops consonants and the adjacent vowels produced by the APE. From an initial group of 22 subjects (17 total laryngectomized and 05 not submitted to treatments for laryngeal cancer), 15 comprised the groups studied as follows: ALA group (10 albedo speakers with PTE, distributed in groups: ALAa: five speakers, age ± 64 years and ALAb: five speakers, age ± 57 years) and LAR group (five laryngeal speakers, age ± 47 years). The data collection procedure (audio recordings) was performed at the Laryngectomized Outpatient Clinic of the Head and Neck Surgery Sector of the Medical School of Ribeirão Preto and at the Integrated Laboratory of Acoustic Analysis and Cognition of PUC-SP. The corpus of the research consisted of six words with the structure CVCV (Consonant - Vowel - Stop Consonant - Vowel), disyllables and paroxitones inserted in a vehicle sentence. In order to meet the objectives, two instruments of analysis were elaborated: a System of Acoustic Classification of the Quality of the Tracheoesophageal Speech and a script, applicable to the PRAAT software, for extracting acoustic measures of stop consonants, highlighting the information regarding voicing contrast (set of 44 measures related to duration, fundamental and formants frequency, and the intensity of adjacent consonants and vowels). The results were analyzed by means of descriptive statistics and multivariate analysis (Discriminant Analysis and Principal Component Analysis). The Quality Acoustic Classification System of Tracheoesophageal Speech revealed three relevant dimensions, in descending order of influence: measures characteristic of the sonority source (harmonics); the vocal tract resonances (formants) and the source of transient noise of stop consonants and adjacent vowels. These dimensions were the subdivision of the ALA speakers group (ALAa: acoustic quality of upper tracheoesophageal speech and ALAb: mean and lower limits). Speech samples from the ALAa and ALAb subgroups revealed a limitation of the maximum harmonic frequency, in relation to the LAR group, in addition to an increase in durations and voicing percentage in non-voiced segments, in a higher proportion in the ALAb subgroup. The influential variables referred to harmonic measurements and those related to the occlusion phase. For discriminant analysis of voicing contrast, considering pairs per point of articulation, the percentages of classification were 89.29% in bilabial sounds, 93.06% in alveolar sounds and 86.75% in velar sounds. The acoustic findings revealed a wide range of mobilizations developed by the alarygeal speakers in the pursuit of the goal of articulated and intelligible speech production / Esta pesquisa integra o campo das investigações da fala alaríngea com respaldo do campo da Fonética Acústica. Apresentou como objetivos analisar, do ponto de vista acústico, a qualidade da fala traqueoesofágica e as características das consoantes oclusivas, e das vogais adjacentes, produzidas por falantes alaríngeos com PTE. De um grupo inicial de 22 sujeitos (17 laringectomizados totais e 05 não submetidos a tratamentos para o câncer de laringe), 15 compuseram os grupos estudados da seguinte maneira: grupo ALA (10 falantes alaríngeos com PTE, distribuídos em grupos: ALAa: cinco falantes; idade ± 64 anos e ALAb: cinco falantes; idade ± 57 anos) e grupo LAR (cinco falantes laríngeos; idade ±47 anos). O procedimento de coleta dos dados (audiogravações) foi realizado no ambulatório de Laringectomizados do Setor de Cirurgia de Cabeça e Pescoço da Faculdade de Medicina de Ribeirão Preto e no Laboratório Integrado de Análise Acústica e Cognição da PUC-SP. O corpus da pesquisa consistiu de seis palavras com a estrutura CVCV (Consoante – Vogal – Consoante oclusiva- Vogal), dissílabas e paroxítonas inseridas em sentença veículo. Para atender aos objetivos, foram elaborados dois instrumentos de análise: um Sistema de Classificação Acústica da Qualidade da Fala Traqueoesofágica e um script, aplicável ao software PRAAT, para extração de medidas acústicas de consoantes oclusivas, com destaque para as informações relativas ao contraste de vozeamento (conjunto de 44 medidas relativas à duração, à frequência fundamental e de formantes, e à intensidade das consoantes e das vogais adjacentes). Os resultados foram analisados por meio de procedimentos de estatística descritiva e de análise multivariada (Analise Discriminante e Analise de Componentes Principais). O Sistema de Classificação Acústica da Qualidade da Fala Traqueoesofágica revelou três dimensões relevantes, em ordem decrescente de influência: medidas características da fonte de sonoridade (harmônicos); das ressonâncias do trato vocal (formantes) e da fonte de ruído transiente das consoantes oclusivas e de vogais adjacentes. Tais dimensões pautaram a subdivisão do grupo de falantes ALA (ALAa: qualidade acústica da fala traqueoesofágica nos limites superiores e ALAb: limites médios e inferiores). As amostras de fala dos subgrupos ALAa e ALAb revelaram limitação da frequência máxima de harmônicos, em relação ao grupo LAR, além de aumento de medidas duracionais e de percentual de vozeamento em segmentos não vozeados, em maior proporção no subgrupo ALAb. As variáveis influentes referiram-se a medidas de harmônicos e aquelas relativas à fase de oclusão. Para análise discriminante do contraste de vozeamento, considerando-se os pares por ponto de articulação, os percentuais de classificação foram 89,29% nos sons bilabiais, 93,06% nos sons alveolares e 86,75% nos sons velares. Os achados acústicos revelaram uma vasta gama de mobilizações desenvolvidas pelos falantes alaríngeos na busca do cumprimento da meta de produção de fala articulada e inteligível

Introdução: A comissura anterior constitui-se em área de infiltração do câncer glótico, mesmo em estádio precoce. Objetivo: Avaliar o acometimento por tumor da cartilagem da comissura anterior em espécimes de laringectomia frontolateral. Métodos: Foram incluídos 48 pacientes submetidos à laringectomia frontolateral por carcinoma espinocelular T1b/T2. Aspectos epidemiológicos, clínicos e análise morfológica histopatológica foram avaliados. Resultados: Quarenta e dois pacientes (87,5%) tinham lesões T1b e seis (12,5%), T2. Trinta e quatro casos (70,8%) apresentaram tecido sadio entre o tumor e a cartilagem tireoidea, 10 casos (20,8%) tinham tumor contíguo à cartilagem e, em quatro casos (8,3%), houve invasão da cartilagem. Não houve maior risco de desfecho adverso nos grupos com infiltração ou tumor adjacente à cartilagem. Grau de diferenciação, índice mitótico, irregularidade nuclear, presença de nucléolo e necrose tumoral não tiveram relação com invasão da cartilagem. Conclusão: A infiltração da cartilagem tireoidea ocorreu em 8,3% dos tumores e não mudou o desfecho em pacientes submetidos à laringectomia fronto-lateral. As características morfológicas não apresentaram significado estatístico / Introduction: The anterior commissure is an area of glottic cancer infiltration, even in early stages. Objective: To evaluate the involvement of cartilage by the tumor of the anterior commissure in surgical specimens of frontolateral laryngectomy. Methods: 48 patients who had undergone frontolateral laryngectomy for T1b/T2 squamous cell carcinoma were included. Epidemiological and clinical aspects as well as morphological histopathological analysis were evaluated. Results: 42 patients (87,5%) had T1b lesions and 6 (12,5%) had T2. Thirty-four cases (70,8%) showed healthy tissue between the tumor and thyroid cartilage, 10 cases (20,8%) had a tumor contiguous with cartilage; and in 4 cases (8,3%) there was cartilage invasion. There was no major risk of adverse closure in the groups with the infiltration or tumor adjacent to cartilage. Grade of cellular differentiation, mitotic index, nuclear irregularity, the presence of nucleolus and tumoral necrosis were not related to cartilage invasion. Conclusion: the infiltration of thyroid cartilage occurred in 8,3% of tumors and did not change the outcome in patients submitted to partial frontolateral laryngectomy. The morphological characteristics did not show any statistical significance